What Is Boerhaave Syndrome?

Sandi Johnson

Boerhaave syndrome is a rupture or tear in the wall of the esophagus. Although numerous factors can cause an esophageal tear, tears diagnosed as Boerhaave syndrome are typically attributed to repeated, forceful vomiting. Tears typically present on the left side of the lower third of the esophagus, causing more vomiting, chest pain, and subcutaneous emphysema, or air trapped under the skin of the chest. These symptoms are collectively known as the Mackler triad. Failure to properly treat tears associated with Boerhaave syndrome can result in death.

Someone with a history of excessive alcohol consumption is more likely to experience boerhaave syndrome and other tears of the esophagus.
Someone with a history of excessive alcohol consumption is more likely to experience boerhaave syndrome and other tears of the esophagus.

Herman Boerhaave, a Dutch physician, first documented the condition in the 18th century. The foundation of Boerhaave's work included studying the relationship between various lesions and patient symptoms. In 1724, Boerhaaver wrote of a Dutch admiral and baron by the name of Jan von Wassenaer who, after hours of feasting, repeatedly and vigorously vomited. A lesion in his esophagus, caused by the vomiting, ultimately led to von Wassenaer's untimely death. During Boerhaave's time, all cases of the syndrome were considered uniformly fatal, remaining so until modern surgical interventions were devised.

Forceful vomiting may lead to Boerhaave syndrome.
Forceful vomiting may lead to Boerhaave syndrome.

Even with surgical intervention, it is estimated that some 30 percent of Boerhaaven cases result in mortality. Most of the morbidity rates associated with these esophageal ruptures are the result of late diagnosis. Early treatment of the lesion is crucial to the patients' survival. Few patients survive without prompt surgical intervention to repair the damage.

Not all patients present with the classic triad of symptoms, making diagnosis difficult. Additionally, late-stage symptoms, such as sepsis and shock, make diagnosis more challenging. Experts estimate that if treatment takes longer than 12–24 hours after a rupture, the patient's risk of mortality rises 50 percent. Waiting 48 hours after rupture to begin treatment typically results in mortality rates of over 90 percent.

According to research, men are more likely to experience a rupture due to Boerhaave syndrome than women. Ratios of male patients to females average 2:1. Patients with a history of excessive alcohol use are also more likely to experience such esophageal ruptures than patients who do not drink regularly. Studies estimate that as many as 40 percent of patients with Boerhaave syndrome are heavy drinkers, with alcoholics less likely to recognize symptoms in time to seek life-saving treatment.

Similar to Boerhaaven syndrome, Mallory-Weiss syndrome also features tears in the esophageal tissue. Unlike Boerhaaven, Mallory-Weiss occurs at the junction of the esophagus and the stomach, in the mucosa. Other similarities to Boerhaaven syndrome include a strong association between Mallory-Weiss and alcoholism. Mallory-Weiss is also associated with eating disorders. While Boerhaaven will result in death without proper care or surgical treatment, Mallory-Weiss is seldom fatal.

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